Healthcare Provider Details

I. General information

NPI: 1285202929
Provider Name (Legal Business Name): JULIE DIANE WITMAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 N 12TH ST
READING PA
19604-1545
US

IV. Provider business mailing address

819 STONE HILL RD
SHOEMAKERSVILLE PA
19555-9045
US

V. Phone/Fax

Practice location:
  • Phone: 610-816-5728
  • Fax:
Mailing address:
  • Phone: 610-927-7388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC011067
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: